Heading Home for a Visit Safeguard your health while travelling

Canadian immigrants often return to their home countries to visit family and friends. In 2010, this group of travellers accounted for 17 percent of international visits made from Canada. Referred to as visiting friends and relatives (VFRs), they are at a higher risk of illnesses related to travel compared to other travellers.

While this information is intended for people returning home, the message is equally relevant to any traveller.

Why are these people at higher risk?

Those returning to their homeland are more likely to become ill for a number of reasons.

The destination is familiar. Many do not seek travel advice and so are not aware of preventive measures available to them.

They tend to take greater risks than other travellers. Travelling despite existing medical conditions is common. Taking a last-minute trip may not allow time for preventive care.

Staying with family may expose them to health risks. For instance, food and water that normally does not cause illness in the host family may easily cause diarrhea in a Canadian visitor. Contact with locals also increases the risk of diseases, such as tuberculosis and meningococcal disease.

New Canadians often believe that they are immune to diseases from their original home. This may be true in some cases, as with immunization against Japanese encephalitis or previous exposure to hepatitis A. However, experiencing an infection does not always ensure long-term immunity. For instance, even those who have had many episodes of malaria are still highly at risk. The risk is even greater for their Canadian-born and raised children.

Illness carried in food and water

Traveller's diarrhea (TD) is the most common illness that affects visitors to the developing world. It affects as many as 30 to 70 per cent of travellers. Bacteria cause most of these illnesses, and viruses and parasites cause a smaller number. Hepatitis A and typhoid are among the other infections passed in food and drink. In order to lessen the risk, be cautious when choosing foods and beverages.

Remember the saying, 'Boil it, cook it, peel it, or forget it.' Foods that are freshly cooked and served hot are generally safe. High-risk foods include raw or undercooked meats, and salads washed in non-potable (not of drinking quality) water. Some cultural foods, such as white cheese (queso fresco) in Latin America, are also of concern. Each year, carnivorous reef fish from tropical waters cause an estimated 25,000 cases of ciguatera poisoning. (This toxin affects the nervous system). Do not drink beverages made from non-potable water. Drinks that are bottled and sealed are generally considered safe.

Another way to reduce the chances of TD is to take bismuth subsalicylate. This is the active ingredient in Pepto-Bismol™. While two of five travellers might normally become ill with TD, taking bismuth subsalicylate drops the rate to less than one in five. However, children under the age of three, children with a viral illness, and adults with certain medical conditions should not take Pepto-Bismol™ due to potential side effects and drug interactions.

TD is treated with rehydration and antibiotics. Packets of oral rehydration solution are available in pharmacies. As well, oral rehydration solutions can be prepared with half a teaspoon of table salt, half a teaspoon of baking soda, and two to four tablespoons of sugar in one litre of water. Your family doctor can provide you with a prescription for an antibiotic.

Avoiding insects

Mosquitoes carry a number of infectious diseases, including malaria and dengue fever. A vaccine is available for some of these infections, such as yellow fever and Japanese encephalitis. However, taking precautions to avoid insect bites is still necessary. Mosquitoes tend to bite between dusk and dawn. Keep outdoor exposure to a minimum during this time. Wearing long-sleeved clothing and using a bed net at night provides a physical barrier against mosquitoes. Insect repellents containing 30 per cent N,N-diethyl-meta-toluamide (DEET) are also effective. Treat clothing with insecticides like permethrin for extra protection. These measures also protect against ticks, which may carry rickettsial bacteria, and sand flies, which may pass leishmaniasis parasites.

To prevent malaria, take the medication before departure. Continue it when the travel is completed. Various medications, such as chloroquine, mefloquine, atovaquone/proguanil, and doxycycline are available, depending on the traveller's age and if pregnant. The malaria strain in some countries may be resistant to certain medications. Your family doctor or a travel clinic can supply information and prescriptions. If you develop a fever after visiting an area where malaria is present, inform your doctor so malaria testing can be done.

Tuberculosis and respiratory infections

One-third of the world's population is infected with the tuberculosis (TB) bacteria. Unfortunately, medication no longer has an effect on some strains. This is an increasing concern all over the world. The TB infection is passed via airborne particles released when an infected person coughs. Avoid exposure to people known to have TB. Time spent in crowded environments, such as hospitals, prisons, and homeless shelters, should be kept to a minimum.

A person infected with TB can have prolonged cough, fever, night sweats, and weight loss. If you have these symptoms and have been travelling recently, talk to your doctor.

The Bacille Calmette–Guérin (BCG) vaccine for TB is not often used in Canada as TB is uncommon here. As well, the vaccine interferes with the skin test for TB, making it more difficult to detect the exposure to disease.
Pollution, smoke and fires can cause other respiratory infections in travellers. If you have an existing respiratory disease, such as asthma or COPD (chronic obstructive pulmonary disease), pack medication to treat it. Vaccination every year against the influenza virus is recommended.

Exposure to wildlife

In many countries, it is normal to encounter animals like dogs, cats, monkeys, rodents, and racoons on the street. In areas where rabies is a problem, these animals may carry the virus and pass it on.

Rabies infection occurs when infected saliva enters the body, usually through a bite wound. If you have been bitten, wash the area very thoroughly and get immediate medical care. Rabies infects the brain and is fatal if not treated. If you are likely to encounter rabid animals on your travels, consider being vaccinated. Avoiding animals may be wise, since they can also carry other diseases including leptospirosis and anthrax.

Creatures like snakes, spiders, and scorpions carry venom that can be passed through a bite. Always wear shoes, especially at night, and avoid sleeping on the floor.

Swimming and beaches

Swimming in contaminated water can cause parasite infections such as schistosomiasis. This affects the liver, intestines, and the urinary system. It is best to avoid swimming in bodies of fresh water where schistosomiasis is regularly found. Chlorinated and salt water (ocean and sea) are generally safe for water activities.

Blood and body fluids

A number of infections are passed through blood and body fluids. Human immunodeficiency virus (HIV), hepatitis B, and hepatitis C are all examples. Besides intimate contact, contaminated medical instruments and transfusion of inadequately screened blood are possible methods of transmission. Other sexually transmitted infections, such as gonorrhea, are also seen in travellers returning home. Take appropriate precautions to prevent the exchange of blood and body fluids.

Injuries

Injuries are the most common cause of death of travellers to the developing world. They include road accidents, drowning, and violent acts like homicide. To avoid violence while travelling, stay with a companion and limit travel at night and in areas of civil unrest. Consider safety when planning transportation and activities.

Vaccinations

Make sure your vaccines are up-to-date and complete for your travel destination. Routine vaccinations may need to be updated. A family doctor or a travel clinic can provide more details.

Medical insurance and health care abroad

Before leaving, it is wise to purchase travel health and evacuation insurance to cover unexpected situations. If you need health care on the trip, a travel insurance company can help locate services. Friends, relatives, and, in some cases, the Canadian Consular Services office may be able to help. In case of an emergency, the best option is often the nearest hospital.

While medical care is generally available, remember that health standards and infection control procedures differ in other countries. Fake medications are not uncommon in many developing countries. Whenever possible, bring your own medications from Canada. A list of commonly used medications is shown in Table 2. If medication must be purchased abroad, buy it from a legitimate pharmacy. Check that it is in its original packaging, and looks like the original medication (in shape, size, and colour).

Even though you are heading to your country of origin, you are still at risk of many illnesses related to travel. Talk to your family doctor or a travel clinic to make sure you are properly prepared. Educate yourself about the potential risks and take action to protect your health, so you can enjoy your time at home.

Table 1: Routine vaccines, and vaccines for travel

Disease

Dosing schedule for adults

As travel vaccines are specific to the destination, not all travel vaccines are required for all destinations.

Routine vaccinations

Tetanus

re-immunize every 10 years

Measles

minimum of two doses

Varicella (chicken pox)

two doses required if no history of disease

Hepatitis B three doses;

initial dose, then repeat at one and six months

Polio

minimum of three doses

Meningococcal

one dose, required for entry into Mecca during Hajj

Influenza

needs to be updated yearly

Travel vaccinations

Hepatitis A

two doses; initial dose, repeat between six and twelve months

Cholera

two oral doses

Typhoid

one dose

Rabies three doses;

initial dose, repeats at seven days and between 21-28 days

Yellow fever

one dose, required for entry into some countries

Japanese encephalitis

two doses, 28 days apart

Table 2:Commonly used over-the-counter medications to consider taking for travel